Comments: Psychiatrist Calls Profession's Leaders Out Of Touch
It's heartening to read such a call to action from a psychiatrist. Unfortunately, though, it seems like much of psychiatry's abuse happens with impunity. Those diagnosed with mental illness are the stigmatized ones, who keep their health histories secret for fear of discrimination, etc. I really don't know how this situation can change. I think of other vulnerable groups - religious or ethnic minorities - and they at least can be open about their group status (and even proud of it.) So I give more kudos to Electroboy, Philip, and others for their tremendous courage. We need it.
Posted by LL at May 21, 2009 07:51 AM
Nada Stotland is an embarrassment to her profession and I cannot fathom how she got to be president of the APA! I have never read such a rambling piece of illogical, out of touch nonsense in my whole life and it follows right on from the assertions she happily pronounced in her Infinite Mind interview. I honestly wonder if she's on something. Sounds like her medical school preceptor was right on when he told her she had a "mushy, unscientific mind." I'm amazed she admits that in print. She seems to have no thoughtful understanding of the criticisms that have been made against diagnostic and treatment paradigms. For one thing, it's not about denying the existence of suffering and symptoms of suffering throughout history; it's about what we're doing now to deal with that. And what kind of defense of psychiatric treatments is it to say other fields of medicine also have harmful treatments? This boggles the mind frankly. She appears to have no concept of spiritual and mental healing. I'm horrified.
And for those of you who may not know this, this is a woman who rolled her own adult daughter out at the December, 2006 FDA hearing on antidepressants and suicidality in young adults to testify that medications had "saved her life." Hanna Stotland recounted a childhood of panic attacks and severe anxiety (I wonder why) and how it all miraculously lifted when she started taking antidepressants (and other meds?) at the age of 17 that enabled her to go on to Harvard and Harvard Law School. More power to her, but I just wonder if we're getting the whole story here. Just why was she having so many problems as a child? Was it really just "brain disease" or a "chemical imbalance" as she would have us believe? Hanna Stotland did work for a prestigious law firm through 2006 but she is no longer in their directory and it's unclear frankly from a Google search what she's doing now. I hope she's doing well but 16 years on psych drugs (she's 33 now) is bound to take its toll and I'd like to hear frankly if it's still going well. Also what will be up if she ever does get married and wants to have kids. I fear for her as I do for everyone who is dependent on these drugs and unaware of the toll that dependency is likely to take on their long term health. Nada just strikes me as a bit too defensive in a knee jerk sort of way to attacks and I wonder if she's got a hidden agenda that has a personal dimension. All very hypothetical on my part but I find Nada Stotland a very troubling character, because she's in a position of considerable influence.
Posted by Sara at May 21, 2009 11:06 AM
Good comments, Sara. I though Nada Stotland came off pretty lame, too. She complained that she didn't have enough time on the TV gig but then when she wrote this article she presumably had plenty of time to organize her thoughts and that ended up being pretty shallow and disorganized too. Perhaps she's just not very intelligent. God knows that true of many in her profession.
Posted by Francesca Allan at May 21, 2009 11:32 AM
Stotland basically admits that psychiatric 'treatments' are brutal and ineffective:
"Critics say that psychotropic medications turn patients into zombies and that ECT fries people's brains." She makes no effort to refute that, just claims that real medicine is no better: "But cancer chemotherapy and radiation poison and burn, all too often without curing disease."
Oncology is a bit of a stretch, since without intervention, most cancers are nearly 100% fatal. I'm inclined to agree with her teacher that she does have "unscientific mind" disorder, subtype mushy.
Posted by UnderTheThresher at May 21, 2009 01:09 PM
Great comment, Sara.
If the daughter was suffering from anxiety and panic attacks, then her serotonin levels were probably already too high. Here is an article from www.SSRIstories.com which shows that the levels of serotonin in unmedicated anxious people are eight times higher than normal. Perhaps this is why the FDA placed the General Warning on antidepressants on March 22, 2004 regarding antidepressants causing/exacerbating anxiety and panic attacks.
http://www.ssristories.com/show.php?item=1898
First sentence of paragraph two reads: "The scientists tested the levels of the mood-regulating chemical serotonin in 20 patients who suffer panic attacks and found that, even on a good day, the average levels of the chemical in the brains of at least 15 of the patients were eight times higher than normal.
http://theage.com.au/news/20000514/A59189-2000May13.html
Dramatic reversal in research on anxiety By STEVE DOW
Sunday 14 May 2000
Startling and unexpected findings on panic disorder patients could
fundamentally change the way anxiety and anxiety-related depression are
treated. The findings by Melbourne's Baker Medical Research Institute, presented
to a recent scientific meeting and soon to be submitted to the medical
journal The Lancet, have unsettled scientists and turned upside down
their ideas on brain chemistry among the anxious. But the evidence from the work by cardiologist Professor Murray Esler and colleagues is so strong that it is being taken seriously.
The scientists tested the levels of the mood-regulating chemical serotonin
in 20 patients who suffer panic attacks and found that, even on a good
day, the average levels of the chemical in the brains of at least 15 of
the patients were eight times higher than normal. Until now, the theory has been that anxiety, panic and anxiety-related depression are caused by a lack or underactivity of serotonin in the brain. Based on this theory, the selective serotonin re-uptake inhibitor
(SSRI) wonder drugs that emerged in the '90s - marketed as Prozac,
Aropax and Zoloft - are intended to increase serotonin around the brain
neurons involved in anxiety. Professor Esler emphasised that the SSRIs were "great drugs" and should remain worldwide bestsellers. However, there were two important implications of the new research, he said. First, the conventional view of how SSRIs operate has been challenged.
It would appear that the drugs are effective because, over time, they
somehow decrease, rather than increase, serotonin as originally thought. Second, the new findings could spark drug companies to create drugs that
stop serotonin directly. Such a response might stop the common problem
of "serotonin agitation" experienced by many patients on SSRIs. These
patients experience increased anxiety in their first weeks of treatment
on drugs such as Prozac, Aropax and Zoloft; the drugs making the problem
"worse before they make it better", Professor Esler said. He said there was now compelling evidence that panic disorder and depression were on a par with high blood pressure and smoking as risk factors for heart disease. A study of several panic disorder patients had shown a spasm of coronary arteries was common after an attack. One
patient, a woman of 40, suffered a clot and subsequent heart attack
because of her panic disorder. The Baker Institute wishes to recruit patients who suffer panic disorders and depression for future studies. Contact the institute on
95224212.
Posted by Rosie at May 21, 2009 01:27 PM
Nada Stotland wrote:
"...Critics say that psychotropic medications turn patients into zombies and that ECT fries people's brains. But cancer chemotherapy and radiation poison and burn, all too often without curing disease..."
Translation: "other disciplines are shite, so psychiatry shouldn't be criticized disproportionately for also being shite."
Hardly a ringing endorsement, is it? It seems Ms Stotland is engaged in a World's Tallest Midget competition with other quacks.
Matt
Posted by Matthew Holford at May 21, 2009 02:51 PM
Now NAMI will cry about nasty STIGMA against shrinks!
Posted by Lilly NC at May 21, 2009 04:02 PM
Rosie, can they measure serotonin levels now? Is this new? Last I heard, they could only do so after death.
Posted by Francesca Allan at May 21, 2009 08:12 PM
Nada Stotland said, "...I still won't stand for ill-informed attacks on our specialty."
What about well-informed attacks on the specialty?
John Gever interviewed Ms. Stotland this week at the annual APA meeting.
Ms. Stotland: "There's no other medical specialty I know of that has its own particular dedicated hate group..." Ms. Stotland seems to be oblivious to the fact that scientologists are not the only critics. Someone should study that. View the entire video here:
http://www.medpagetoday.com/MeetingCoverage/APA/14276
Posted by Anonymous at May 21, 2009 10:19 PM
"And for those of you who may not know this, this is a woman who rolled her own adult daughter out ..."
Maybe we should keep personal attacks out of this.
Posted by Johnathon at May 22, 2009 09:03 AM
Hi Francesca,
Serotonin can be indirectly measured through cerebrospinal fluid (CSP)
Just now read your question. Sorry my answer is so late in arriving.
Posted by Rosie at May 22, 2009 01:58 PM
Thanks, Rosie. But how do cerebrospinal fluid levels of serotonin correlate to brain levels of same? My understanding was that serotonin is the ultimate multi-tasker and is found throughout the body. I'm really curious about this because I've always suspected the alleged SSRI mechanism is bogus. Is there now a direct link between cerebrospinal and brain levels?
Posted by Francesca Allan at May 22, 2009 07:28 PM
Hi Francesca,
Perhaps this Website will give a better explanation of measuring serotonin levels in the brain. The levels cannot be measured directly, of course, so this method is somewhat useful. I have copied and pasted the revelant information underneath the Website address.
http://www.palace.net/~llama/psych/pharm.html
"Since it isn't possible to measure serotonin levels directly, researchers have to find substances whose levels correlate to serotonin levels. Two commonly used techniques are measuring serotonin metabolites (breakdown products) in spinal fluid and measuring the number of imipramine binding sites on platelets. Lower levels of metabolites or fewer platelet imipramine binding sites indicate low levels of serotonin in the brain. Another very useful technique involves measuring how levels of a hormone called prolactin change in response to administration of a drug called d-fenfluramine. A blunted response indicates decreased levels of presynaptic serotonin. This method gives more precise information about neurotransmitter function
Posted by Rosie at May 22, 2009 09:32 PM
Hi Francesca. I'm going to try to explain my understanding of what's going on with the neurotransmitters to see if it helps and how it relates to what the drug companies present in their advertising. People experiencing anxiety and panic (i.e. stress) are being flooded with stress hormones and presumably higher levels of certain neurotransmitters (in an elaborate feedback mechanism). One of these is almost certainly serotonin. While we don't know what the "normal" levels of serotonin are because they change according to stress levels and how one reacts to stress, it is probably true that changes in levels can be measured by taking cerebrospinal fluid and detecting levels of a serotonin metabolite. This is a rough proxy for serotonin levels and if they are higher in cerebrospinal fluid I guess they are probably higher in the brain. I believe serotonin is probably higher under stress not lower but it may not really matter. The point is that drugs like Prozac do increase serotonin levels initially by the mechanism that's described by drug companies. What they fail to mention however is that the brain is an incredibly complex feedback system and is constantly monitoring the "allostatic load." When you mess with one neurotransmitter you set off a whole chain of reactions that affects all the other ones too. So when serotonin goes up, dopamine goes down (as an example). Furthermore once the brain detects that the serotonin is being "artificially" increased it tries to shut that production down to get back to what's appropriate for the allostatic load at that time. That's why when you start an antidepressant your agitation increases at first but after you've been on a while the production slows way down and you get blunted. But it's far from a perfect system and taking pills like this is far from a precise mechanism. Antidepressants are very far from being "selective." They are affecting the whole feedback system of the brain in a very artificial way and levels of myriad neurotransmitters as a result, not just serotonin. I hope this helps your understanding. That's why Glenmullen speaks of a Prozac "backlash." The brain reacts strongly to having its feedback mechanism fooled with. This is just a lay man's explanation and no one really knows exactly all the different implications of this process but I think it's probably closer to the reality than what you'll see on a drug company site. Glenmullen's book Prozac Backlash has a pretty scientific explanation of some of these processes.
Posted by Sara at May 23, 2009 08:17 AM
Measurements in CSF are a poor proxy.
Let's pretend we know what mental illness is, how the brain is involved, and which specific parts or brain neurotransmitters should be measured. Let's also pretend we understand what the population baselines are and how you, specifically, relate to to the overall population (accounting for ethnicity, environmental factors, social status, metabolic genetics, and so on...)
It might be possible to use CSF as a biomarker if there was someway to determine that localized NT levels would be observable in CSF in general. Good luck. That's akin to determining who in the auditorium went to the supermarket. Furthermore, you'd want to know what they bought and from which isle. So, even if you had a shopping bag to suggest who the shoppers are, and even if you get to see what's in the bag, you don't know if people switched bags or items. You don't know if the items in the bags even came from said supermarket. You'd still have a better chance divining market shoppers from NT levels in CSF.
The best you can say is that NT levels in CSF appear to be such and such, but this in no way suggests specific brain NT levels or which tissues.
Why not just measure in the gut? Surely there must be a suitable proxy for the blood brain barrier (nope again). I don't think I submit to a cervical puncture for this sort of data.
Posted by Paul at May 23, 2009 11:19 AM
As a member of the psychiatric profession, I confess that I was embarrassed by Stotland’s editorial. It was sheer nonsense. And, even though I hate to say it, it was just plain DUMB. If this is the best that our profession can do to answer our critics, we are in deep you know what. Stotland basically defended psychiatry by trying to characterize ALL fields of medicine as unscientific. We don’t REALLY know the cause of any disease, mental or physical! We don’t REALLY cure any disease, mental or physical! I couldn’t believe it! It was as if she were saying: “Don’t criticize us. All doctors practice witchcraft, not just psychiatrists! So leave us alone!” If this keeps up, people will indeed leave us alone – and we will have nothing but empty appointment schedules to show for it!
Posted by Tom at May 23, 2009 05:52 PM
All this discussion about serotonin levels has just reminded me of a piece I read, some time ago. It was by a neurosurgeon, if I remember, aright, and he was having a "pop" (ie, criticizing), at the whole serotonin imbalance thing.
Let's make some assumptions, just for the sake of argument:
1. Measuring sertonin levels *anywhere* in the body provides an accurate indicator of levels of serotonin in the brain.
2. We know accurately what the normal brain serotonin level of a healthy individual is.
3. We can impact serotonin levels with drugs.
Now, it seems to me that those are big, fucking assumptions, but what the hell, eh? So, given the complexity of the human brain, where there are millions of synapses for every part of the brain the size of a pinhead, just how is the blunt administration of n microgrammes of a given drug going to *accurately* redress the deficit/surfeit of serotonin that we have established to exist (by measuring spinal fluid levels of serotonin)?
I stand to be corrected, as ever, but the whole thing is fantasy, as far as I'm concerned. It's easier to fix yourself.
Matt
Posted by Matthew Holford at May 23, 2009 08:21 PM
Tom, you wrote "If this keeps up, people will indeed leave us alone – and we will have nothing but empty appointment schedules to show for it!"
I think that's already happening! I appreciate your candid remark, and boldly I say that the great day will be when psychiatry understands the brain even remotely! and stops throwing drugs at it, when "they" don't even know how the brain works or how these drugs work.
One day, after 5 yrs of a psych medicating my daughter for a wrong dx, I told him this:
"it's not what med works for her, after 5 yrs it appears all you have found out is that meds DON'T work for her"
He was speechless, as it was the truth. The brain is so complex, and here we are dealing with drug companies and scandal, and wondering WHY these drugs don't do anything except create side effects!
DUH!
Posted by Stephany at May 24, 2009 09:44 AM
Would about measuring neurotransmitter levels in the brain using functional neuroimaging? In other words, marking serotonin with a radioactive tag and watching its levels in different areas of the brain in different mental states, compare those levels between someone with, say, depression versus someone without depression. You could measure the density of neurotransmitter receptors, too.
Posted by dguller at May 24, 2009 12:17 PM
Human beings are not science experiments
You deny the lived experience, you even deny their soul; and for what? So psychiatry can go off on another witch hunt for neurotransmitter levels.
Who are the crazy ones when spouting insane crap like this in another silly attempt to validate made up diagnosis and insane treatment options.
Maybe you should stick with eugenics, since that one proved to work out so well also.
Posted by bugger-off at May 25, 2009 12:16 PM
Sorry, I do not deny "lived experience" and have never endorsed eugenics.
But you are right that I do deny the existence of an immortal and unchanging substance that continues to exist after our physical bodies die.
I do not have to believe in such an entity in order to love, to care, to find meaning and purpose, to suffer, to feel the deep interconnection between all beings, i.e. to be human.
However, if by "soul", you mean the collection of mental states, capacities and behaviours that represent the best and highest that a human being aspires to be -- e.g. empathy, compassion, love, courage, patience, and so on -- then I do not deny the existence of a "soul". However, I prefer to view those features as byproducts of our biological and cultural evolutionary history, not as divine and immortal implantations.
I think that if you believe that in order to be truly human, we must have an immortal soul, then you have a far inferior view of human beings than you ascribe to me.
And if you think that our mental life has nothing to do with the physiology of our brain, then I wonder how you can account for the effect of illicit drugs, for example?
Posted by dguller at May 25, 2009 12:54 PM
dguller wrote:
"Would about measuring neurotransmitter levels in the brain using functional neuroimaging?.."
I didn't think that that was possible. That is, it *is* possible to visualize brain activity by this means (neuroimaging), but that that doesn't tell one anything about brain chemistry. My reading is by no means exhaustive in this area, though, so I stand to be corrected.
Anyway, I've all but given up trying to explain my ideas on mental illness. "Mental illness," as far as I can assess is a belief, or set of beliefs that one has, that others tell one is/are incorrect, and yet refuse to explain what one should believe, and why (thus causing massive confusion, and ultimately an inability to function). That's obviously massively generic, but it appears to fit all cases (I like to understand things in this way, in case you hadn't gathered!). In other words, mental illness is a problem that one has never solved, and won't, because nobody will assist one.
As far as I can establish, people believe the things they do, because they are instructed to believe them, and if this process of indoctrination is sufficiently compelling, they will then ignore evidence to the contrary, in order to uphold the original instruction. It's extraordinary to see this process at work. In order to unpick a mistaken belief, one must present truly compelling evidence, but this can be traumatic, because it requires a person to abandon their existing belief system, and should never be done coercively (it is, after all, not necessary for everybody to believe the same things that one does).
It's a minefield, in other words. You're a braver man (that's just an expression, by the way: apologies if you're a woman!), than I, for taking the challenge on. Although you are getting paid for it!
Matt
Posted by Matthew Holford at May 25, 2009 05:54 PM
"And if you think that our mental life has nothing to do with the physiology of our brain, then I wonder how you can account for the effect of illicit drugs, for example?"
Which illicit drugs would you be referring too? The ones your profession used to use for behavior control, or those new ones your profession uses now to control behavior?
Here we go again down the same old futile road. Please tell us how your new poisons don't harm the brain like the old ones do. You really are a piece of work.
You say you don't believe in eugenics, yet your repackaged eugenics lie is in the neurotransmitters, chemical imbalance, genetic markers, and serotonin levels. It is all theory now, as it was all theory then.
When you have proof, make your argument. If you want to debate theory; why don't you do it somewhere without those damaged by your lies.
As far as the living soul that lives today and lives on beyond this finite existence; you believe what you want and see how much respect you receive among the patient populations you govern over.
I can only imagine about the same level of respect you have earned here in this forum.
Which is evidenced by the negative responses you garner; very little indeed.
End of discussion with your kind
Posted by bugger-off at May 25, 2009 06:05 PM
Bugger-off:
First, with regards to “illicit drugs”, I was referring to illegal drugs, such as LSD, PCP, cocaine, and so on.
Second, I am a critic of the “chemical imbalance” theory of mental illness. I have said it is an oversimplification that was largely driven by the marketing needs of pharmaceutical companies. A great book on the subject is called “Blaming the Brain” by Eliot Valenstein. You should read it, because it is very informative. However, it does not follow that neurotransmitter levels and activity in different neurocircuits is irrelevant to our mental life, and certainly should be studied.
Third, you mention the importance of proof and argument. I would love to hear your proofs and arguments for an immortal soul. I understand how such a belief is emotionally reassuring – assuming one isn’t destined for eternal damnation! – but how a proposition makes one feel is largely irrelevant to its truth or falsity. So, you will convince me if you can clearly state (a) what a soul is and what it does that makes it so essential, and (b) how you know about the soul. That would be most appreciated.
Fourth, I am clearly aware of the negative responses that I have received here. I do not blame anyone for being harsh with me, especially given their history with my field.
Posted by dguller at May 25, 2009 07:20 PM
Matthew,
Any person who claims that knows anything about the brain is a liar.
LOL
Measuring this, measuring that... what to do with the data?
Creating psych-drugs? Cocaine must be great! At least it's been told that people feel happy for a few hours. They pay with depression when the effect goes away. And... all we know.
Well, the only good outcome about these drugs is being used in wars.
They are using many drugs in soldiers when they are at the battlefield for many purposes.
Perhaps this is one of the reasons soldiers are killing themselves. I said "perhaps".
For bad things these drugs have already demonstrated that they are great!
Posted by Ana at May 26, 2009 01:55 AM
bugger-off,
Isn't it amazing that "this kind" are always here?
LOL
I never saw a good Therapist, I said good.
The good therapists don't have time to be at blogs.
They work hard to help their patients.
Good psychiatrists, yes they exist, also don't have time to be at blogs.
They work hard to help their patients.
I'm amazed that claiming that "I don't agree with chemical theory imbalance" is being used as a way to show that "I'm a good psychiatrist".
Dear Lord! Who has the guts to say that this is true by the time antipsychotics are being used to treat depression and even the mainstream media have already published some articles claiming that there's not such a thing?
It's funny!
Sometimes I come here to laugh a little.
No Philip! Never laugh about what you write. On the contrary. Sometimes I stop coming because you do a wonderful work and it aches knowing that few people know... the TRUTH.
Thank you for your work Philip.
Posted by Ana at May 26, 2009 02:08 AM
Philip,
How I wish to know the name of this psychiatry who said:
""The upper echelon of psychiatry has become so corrupt, complacent, and out of touch with the daily dealings in clinical care, that anyone who makes political decisions in this field that shows no consideration to the impact of diagnosis and care of psychiatric disorders as previously defined as appropriate and responsible, should be removed from whatever office or level of impact on care matters for the sake of patients and responsibly invested clinicians.
"And, where warranted, criminal investigations should be considered and implemented to show there are ramifications for irresponsible, unethical, unwarranted behaviors and interventions in clinical care that cause harm and malfesance. In other words, it is time for people who give a damn about the profession of psychiatry to stand up to the alleged leaders of this field and tell them to go to hell--just retire or find an alternative line of work. Leave the profession to those who take health care seriously and respect the Hippocratic Oath and practice based on principles and documented treatment interventions, not about money or standing in the profession.""
Thank you doctor!
I want to have these words at my blog.
Posted by Ana at May 26, 2009 02:12 AM
Ana wrote:
"Any person who claims that knows anything about the brain is a liar..."
I am pleased to announce, then, that I know nothing about anybody's *belief system*. Other than my own, of course! Strangely, I've found, when I attempt to explain what I believe to be true, I tend to be told that I am mistaken, or stupid, or something of that nature, but only when the things that I believe countermand the beliefs of others, I've found.
It seems, then (given my somewhat limited experience), that other people experience difficulty accommodating my beliefs (and often me, in my entirety), within their own belief systems, which I find to be a curious approach to life. Never mind: as long as nobody validates me, they'll be able to avoid getting drawn into my reality (this technique of breaking rapport is apparently widely used clinically (and in the wider world)). Or so they think!
Matt
Posted by Matthew Holford at May 26, 2009 03:30 AM
Matt:
If I understand you, then you are saying that a “mental illness” represents an inner conflict within a person between what they DO believe and what others (e.g. authority figures) say they SHOULD believe (without providing justification for why), resulting in an inability to function. The problem then lies in the fact that they are not provided with any assistance to resolve the conflict by rejecting their beliefs, rejecting others’ beliefs, or finding a higher synthesis between the two.
That is an interesting theory that I have come across before in my reading of psychoanalytic literature. I think that it runs into problems, because it is too general and appears to describe what EVERYONE goes through at different points in their life. However, not everyone suffers or will suffer from mental illness.
The question is what is it about those with mental illness, according to this model, that makes them unable to reconcile the cognitive dissonance that results from the contradicting set of beliefs brought to their conscious awareness? Most people are easily able to rationalize their way out of the problem without subsequent problems.
Any thoughts?
That being said, I think that you are absolutely right that your theory applies to a wide class of individuals with mental illness, and that the inner conflict that they experience must be addressed in their treatment. Certainly medications play little, if any, role in this regard.
Posted by dguller at May 26, 2009 07:46 AM
Ana:
I know that the brain is made of neurons.
Thus, I know something about the brain.
Does that make me a liar?
Posted by dguller at May 26, 2009 10:09 AM
Sara:
I just read your last post above.
That was an excellent explanation, and I just wanted to thank you for sharing it and presenting it so well.
Posted by dguller at May 26, 2009 10:14 AM
Let me rephrase:
Anybody who claims that with the actual data available can understand and make any kind of change in order to heal mental health is a LIAR."
That's what I meant.
Not only a liar but criminal.
There are enough data of the crimes these psych-drugs that coincidently makes all this mess by changing the same neurotransmitters that drugs like cocaine and others change: dopamine and serotonine.. blah blah blah...
What about the numerous neurotransmitters that are not even know?
What about...
I'm tired of typing.
Philip, please! Ask the psychiatrist who wrote the quotation you left in the post "Psychiatrist Calls Profession's Leaders Out Of Touch" to visit the blog and write something for us.
I know he has no time and I'm afraid he only uses the computer to get e-mail, no it's done by his secretary... anyway... I would love to have a good psychiatrist visiting this blog. Thank you.
I guess I'll put an ad at newspapers: "Good, ethical and tender psychiatrist wanted. Please refer yourself to http://www.furiousseasons.com/ and.... I hope Philip is in a good mood!
Posted by Ana at May 26, 2009 12:54 PM
Matt said:
"Strangely, I've found, when I attempt to explain what I believe to be true, I tend to be told that I am mistaken, or stupid, or something of that nature, but only when the things that I believe countermand the beliefs of others, I've found."
I suffer the same problem especially when talking about the side effects, withdrawal symptom from psych-drugs.
Thanks the Lord I found a psychiatrist that at least nod when I report him side effects.
But he still forget it took me 19 months to get out of Effexor... my suicidal ideation; attempting
suicide and I never told me the violent behavior I experience because it was mild... didn't kill anybody.
But even if I had killed I'm sure I would be in jail!
Sorry Matt. I'm digressing.
Posted by Ana at May 26, 2009 01:01 PM
dguller wrote:
"...That is an interesting theory that I have come across before in my reading of psychoanalytic literature. I think that it runs into problems, because it is too general and appears to describe what EVERYONE goes through at different points in their life. However, not everyone suffers or will suffer from mental illness..."
You know, one of these days, I'm going to say something original! Who developed that theory, and when? If it was relatively recently, perhaps I'll chance my arm and sue them for copyright infringement!
Anyway, absolutely: pretty much everybody is faced with these scenarios, where they are "caught in the middle," with insufficient information to proceed, and wary that the wrong move will lead to them being punished, in some way. Some people create this type of situation deliberately (blackmail), bargaining on a person's fear of loss of reputation/public condemnation being greater than their concern that they are being asked to give up cash that they can't afford. Another example might be the workplace, where one is being asked to do something dubious, suspecting that a failure to comply may result in covert punishment/ostracization, etc, but that if one proceeds, if things go wrong, those who ordered one to act will deny everything. And so on. The person caught in these scenarios is torn, almost literally - can you imagine the damage that that sort of thing must cause, especially if their belief system tells them that the type of action suggested is utterly inappropriate, not to say logically indefensible?
Yes, absolutely, most people do resolve this sort of thing, but in the two examples I gave, the only thing to do is to walk away, or else go to the police, with all the repercussions that that action might entail - not least if one has no material evidence, and in reporting what's happening, one implicates oneself, to some degree. And what if one is torn further? It might be that the people placing one in this position were formerly one's friends, or so one believed. Or it might be that one cannot believe that a person regarded as respectable and civilized could possibly engage in this type of behaviour (ie, placing one under enormous pressure, such that one is almost inevitably the loser, whatever happens). One's overwhelming sense is that something is very wrong, but that there is insufficient information to make a proper call.
I think the question you raise about an individual's inability to resolve such an incident is dependent upon far too many factors to adequately address, in abstract. What weight does a person put on the friendship, for instance (in the work example)? How much evidence do they have that what they are being asked to do is illegal/immoral/will cause a third party great upheaval? It is the incidents that are so finely balanced that the call is difficult to make, I think. An incident could be finely balanced for any number of reasons, dependent largely on the individual, and the weight that they put on the various factors at play.
Like I wrote: difficult to discuss in abstract. A case study would be required to illustrate this concept properly, I think, but one would have to bear in mind that the things that a person found irreconcilable were likely peculiar to them, and not necessarily objective. If one made numerous case studies, one might be able to see a trend (ie, the same kind of things being mentioned as factors, over and again), but one could never approach a new client, believing one had a ready made solution in the sense of the Freudian concept that a given dream/recollection/whatever always means the same thing, from person to person (I'm not sure if that idea is still followed, if it ever was).
Anyway, just my tuppence 'orth.
Matt
Posted by Matthew Holford at May 26, 2009 01:12 PM
"...That is an interesting theory that I have come across before in my reading of psychoanalytic literature. I think that it runs into problems, because it is too general and appears to describe what EVERYONE goes through at different points in their life. However, not everyone suffers or will suffer from mental illness..."
LOL
I don't read dguller because for obvious reasons.
Thank you Matt for this pearl!
This is the kind of Therapy a psychiatrist can offer.
I have said many times here that Therapy has nothing to due with what is being practiced by many.
Here we have a great example.
This "psychoanalytical literature" is either a manual or the reader did understand nothing.
Too general...
Dear Lord!
Matt,
I'm sorry. I will read you later because now I'm having a hilarity crisis.
I must have any drug...
Lol
There's another possibility: the book was terrible translated... :)
Posted by Ana at May 26, 2009 02:04 PM
Let's not forget that the underlying data of those pretty brain scans have been thoroughly processed. The picture that you see is not the raw data, but rather a statistical representation - colour enhanced for your viewing pleasure...
This reminds me of some recent supernova images that appear to show an expanding gas cloud of stellar proportions (pun intended). The reality is that the so-called expansion is, in fact, a static cloud from which we are receiving light at successive time intervals - giving the illusion of motion. Without a fundamental understanding it's easy to be fooled by pretty pictures.
Functional imaging is a neat research tool, but it's not ready for the clinic. I truly believe this fascination with technobiogenetics (I just made this word up) is leading us away from the human aspect with little to show. None of these things address the critical problems of housing, employment, decency, accommodation, understanding, compassion, and love. We need to get our eyes away from, the screens and start dealing with people and their experiences. We need to reject forced treatment and extend a hand instead. Treatment based on mutual trust and respect cannot be delivered at the point of a gun.
Posted by Paul at May 26, 2009 02:32 PM
"'Mental illness,' as far as I can assess is a belief, or set of beliefs that one has, that others tell one is/are incorrect, and yet refuse to explain what one should believe, and why (thus causing massive confusion, and ultimately an inability to function"
Yes, the old double-bind theory of schizophrenia. You described a variation of it.
Still, when a person experiences mass confusion from the double-bind, then their stress hormones become raised and throw the brain's neurotransmitters off-balance.
This can also happen chemically or artificially by giving the person a drug which will throw the brain's neurotransmitters into chaos. Many people with the Prozac Survivor's Support Group commented on this 'mass confusion' - some even indicating that they had feelings from childhood or from their later youth, or even in their 30's and 40's where an incident which had not bothered them for years [or which they were never even aware that it had bothered them] became an uppermost horror in their minds.
Perhaps, this is why "confusion" is listed as a frequent side-effect to the SSRIs. Also, it could be the reason that "paranoia" is listed as Infrequent as a side effect instead of Rare.
Posted by Rosie at May 26, 2009 05:06 PM
I wish I had had a psychiatrist that thought like Paul. Then, I wouldn't have needed therapy to try and deal with my psychiatric hospitalizations.
Posted by Lisa at May 26, 2009 05:37 PM
Ana wrote:
"...Thank you Matt for this pearl!.."
No worries.
Anyway, let's say, for the sake of argument, that either I or my literary predecessor are right, and that this business of "conflicting messages," which is what it appears to boil down to, is correct, to the extent that it *does* cause the phenomenon known as "mental illness".
That is only interesting if we are able to use that information to reverse the process, I think.
Matt
Posted by Matthew Holford at May 26, 2009 05:52 PM
Rosie wrote:
"Yes, the old double-bind theory of schizophrenia. You described a variation of it..."
If a person has two options, both of which are equally (in)valid, such that they are unable to make the choice themselves, then isn't it logical to help them past that? I dunno, it just seems to me to be a strange kind of torture to know the answer, oneself, and to refuse to give that information up for another's benefit, when one perceives that that other's life quality is massively diminished for wont of the assistance - rather like a sadistic teacher demanding the answer to a thorny maths problem, which they know is beyond one's capabilities.
Matt
Posted by Matthew Holford at May 26, 2009 06:26 PM
Paul:
I don't understand your objection to the processed images of functional imaging. Does the fact that they are processed by computer programs invalidate the end product? I don't see why.
Other than that, I agree with your post. It is easy to be seduced by bio-techno-genetico ... or, whatever you called it -- ;) -- and to lose sight of the unique individual who is in psychological distress. I don't think that a deep understanding of the human brain will replace the interpersonal matrix within which we must operate and transform one another, but it could provide important information to help guide treatments.
We certainly are only beginning this project, and have much, much more to learn.
Posted by dguller at May 26, 2009 07:21 PM
Matt:
Umm, the "pearl" that Ana was referring to was my comment about the overly general nature of your explanation of mental illness, which would appear to imply that everyone should be mentally ill. Apparently, my remark demonstrates that I misunderstand psychoanalysis, or something :S, which she finds very humorous. :)
Posted by dguller at May 26, 2009 07:23 PM
Ana:
It may surprise you that I do read some psychoanalytic literature.
The writers that I truly enjoy and have learned a great deal from include Daniel Stern, Peter Fonagy, Stephen Mitchell, James Fosshage, Donna Orange, Robert Stolorow, and Paul Wachtel. I especially like their integration of attachment theory, self psychology and the intersubjective and relational approach to therapeutic change.
Who are the psychoanalytic authors that you would recommend?
Posted by dguller at May 26, 2009 10:29 PM
Guller ..
You seem to think that, anyone who believes in the soul is naive and you seem to think that you have some kind of superiority over those who believe in the soul , as is evident by your patronizing, condescending and dismissive tone here whenever the issue of the soul is being discussed.
The idea and notion of a soul is different to everyone, some see it as religious thing or an extension or part of their religious beliefs, others see it as spiritual or an indefinable but wholly felt presence. The idea of "soul" means many different things to many different people. Whatever the soul is, is not or even whether it exists or not , is not really the issue. What speaks volumes to me , is the fact that you are 100 % closed off to even the slightest possibility that something like the soul can exist therefore this leads me to believe you to be closed and narrow minded.
The most dangerous beliefs are those held with absolute conviction.
Or as
Friedrich Nietzsche said -
"Convictions are more dangerous foes of truth than lies"
If you are a scientist (as you say you are) then you should know that until something can be proven true or untrue , then the hypothesis is still a matter for debate...
Posted by truthman30 at May 27, 2009 12:40 AM
The end product is wholly subservient to numerous assumptions in the statistical methods in aggregation. The images are not photographs of anything real. They are imputed visualizations. It is important not to confuse the two. Useful for research, but not suitable for clinical diagnosis.
Posted by Paul at May 27, 2009 01:06 AM
I guess to put it in other terms, my objection is that I can show you an x-ray film to reveal a structural physical problem - it is not a model, it is real (at the time the photo was taken). Brain scan images are represented to lay people as like an x-ray film or photograph - that they too are images. This is a false comparison. These scans are based on mathematic models which are rendered for display - this is what you are observing, not an image of actual brain activity or anything else that is real. One is a picture of real biology, the other is a rendered mathematical model from which biological function is implied.
Furthermore, these models have not adequately resolved what should constitute "normal" from "diseased". There is significant overlap which points to the immaturity of the modeling. False positives are literally guaranteed. Reproducibility within individuals and groups is most unimpressive and is therefore ill suited for clinical use (let's not forget the cost and radiation exposure).
I'm not interested in pretty pictures. This won't help me understand a person or how I might help them. It's a distraction - technobabble to give the air of scientific authenticity.
Posted by Paul at May 27, 2009 01:32 AM
dguller wrote:
"Umm, the "pearl" that Ana was referring to was my comment about the overly general nature of your explanation of mental illness, which would appear to imply that everyone should be mentally ill..."
LOL. Perhaps everybody *is* (mentally ill)!
Many people have written about the difficulty of understanding language. No amount of words can communicate a concept as much, nor as quickly, as a picture. If we are then trying to communicate an abstract concept, such as mental illness, we needs must use analogy, metaphor, and so on, in order to try to convey our meaning. And we will still come up short, not least because different people apply subtley different meanings to words.
I could show you a person's behaviour, and you might suggest that the behaviour you were observing indicated mental illness, and yet we have no idea of the stimuli and constraints that a person might be labouring under. And we would have to care, in order to find out.
Ana has had some pretty unpleasant experiences with psychoanalysis, as far as I can gather. A lack of empathy (worryingly), amongst them. You may argue that you are not the consultant who gave her this experience, and do not deserve to be treated with the disdain that she shows toward you. But experience is an ugly thing, sometimes - like Pavlov's dogs, we make our associations - and you're bearing the fallout of that.
Similarly, I will never place myself at the disposal of an authority figure, again, because the last couple I've had experience of have been corrupt, useless and incapable of communication, in my opinion. My dissent is just vaguely more urbane, and polite, but nobody is getting past my defences.
Matt
Posted by Matthew Holford at May 27, 2009 04:23 AM
Paul:
What about ultrasound, CT, MRI, SPECT and PET scans? They are not direct snapshots, like a photograph or a plain film X-ray (which are now also processed since they are usually digital). They are computer generated images secondary to mathematical programs, which include statistics! I don't think you would also say that they are "Useful for research, but not suitable for clinical diagnosis".
Your objection about differentiating between "normal" and "abnormal" is fair, but it is also present in ordinary laboratory values. Some people have thyroid levels, and yet still present with hypothyroidism symptoms, mainly because of how the thyroid hormones are metabolized and utilized by their bodies.
I believe the same holds for many other objective measures of medical illnesses. In other words, there are always going to be people who present with signs and symptoms for illnesses while having objective tests being normal. This is a simple product of the wide variability between human beings, and does not imply that medicine is somehow fraudulent.
Regardless, your position is that the current research base is insufficiently large and thorough to be clinically useful, and there is truth to that. My reaction is to call for more research to improve out understanding, which would include further advances in understanding the human brain, which would include the use of functional imaging as a useful tool.
Would you agree with this call for further neuroscientific research?
Posted by dguller at May 27, 2009 05:03 AM
truthman30:
Please point out where I categorically denied the very possibility of a soul. I said that I do not believe in the immortal soul, because of insufficient evidence for its truth and usefulness. I did NOT say that such evidence is IMPOSSIBLE, and thus there should be NO debate. No. What I DID do was ASK for PROOF and EVIDENCE in order to HAVE a debate. See the difference? (Probably not.)
So, let's have that debate, and let's keep the personal attacks to a minimum (if possible). When I disagree with someone that does not automatically imply that I believe that I am superior, arrogant, closed-minded and so on. It just means that I disagree. I'm sorry to say that there is nothing else going on.
After all, I can name you several beliefs that I have changed or revised followed discussions here with posters. Can you name a SINGLE belief that you have changed following any of our dicsussions? If not, then who is the truly closed-minded one? Or maybe I simply haven't convinced you, which could be due to my poor arguments, rather than any character flaws on your part. I'm willing to assume the former about our disagreements, but you constantly assume the latter about me. Oh well.
Now, I asked two questions earlier that I think should be answered in order to strengthen the position of those who believe in an immortal soul.
Please tell me (a) what a soul is and what it does that makes it so essential, and (b) how you know about the soul.
Thanks!
Posted by dguller at May 27, 2009 05:17 AM
dguller wrote:
"...Apparently, my remark demonstrates that I misunderstand psychoanalysis, or something..."
Thinking about it, I've just realized that I have no idea what psychoanalysis is, or seeks to achieve, or anything, really! What is the objective, as a matter of interest, and how does psychanalysis seek to achieve the objective?
Matt
Posted by Matthew Holford at May 27, 2009 06:20 AM
Matt:
Psychoanalysis is not a monolithic entity, and thus it is hard to say how something as heterogeneous as psychoanalysis "seeks to achieve". After all, there are the classical Freudians, ego psychologists, object relations school, Kleinians, self psychologists, intersubjectivists and relationalists, to name a few. They all differ on various key points.
However, perhaps a common thread would be that all schools state that psychological distress is secondary to internal conflict or tension that is the result of an inadequate developmenent during the course of one's life. Severe emotional distress is thus a consequence of current relationships activating past maladaptive emotional responses acquired during difficult earlier periods, and occurring outside of our conscious awareness (i.e. transference).
The treatment consists in both bringing that conflict into conscious awareness in order to exert some control over it through interpretation, as well as to provide an environment of empathic listening in order to counteract the invalidating experiences of the past (e.g. the corrective emotional experience). The focus is both upon the content of what is said, as well as the therapeutic relationship itself, which is looked upon as the primary vehicle of healing.
At least, that is how I try to lump them together. Perhaps someone with more familiarity with the literature can point out a better account.
Posted by dguller at May 27, 2009 11:18 AM
All the pretty pictures in the world won't change the fact that psychiatric diagnosis is and always will be based on clinical assessment of arbitrary symptoms. They can get back to us once they can diagnose on the basis of the scan images only.
Posted by Francesca Allan at May 27, 2009 11:37 AM
Do really have to continue the silly game of you asking me questions that we both know the answer to? I can't possibly imagine you don't understand the difference between the lack of clinical utility of brain scans versus imaging a broken bone or a cancerous tissue. Please spare me. A digitized x-ray of a broken bone doesn't imply that a mathematical model defines what a broken bone is... Again, comparing apples and oranges.
Please no more rhetorical questions. It adds nothing to the discussion.
Posted by Paul at May 27, 2009 12:42 PM
Don't hold your breath Francesca.
Brain imaging is of little use for "mental illness" as presently contrived, imo. What's needed are objective tests that can be correlated with the scans, but this doesn't exist today. Those who believe in technobiogeneticbabble will press on further attempting to reduce the human experience to equations and lab values.
Meanwhile, I think people are better served now by your time, attention, love, and understanding.
Posted by Paul at May 27, 2009 12:56 PM
Matt,
Psychoanalysts who only follow the multiple bibles are not good.
Those who are most capable have to study other fields such as Philosophy, Literature, Art (yes, Art), Politics... most everything related to human beings.
And they must, of course, know how to listen.
Yes, listen. Not only because of the psychoanalytical process but this is the characteristic of those who really care about others.
I assure you that there are good therapists who cares a lot about their "analisandos" (sorry don't know the English word - those who are know as "patients" but this is not what a person is when s/he is at a psychoanalytical session).
Good therapy is the work of two YOU are the most important but strangely as it may seem you can have the best psychoanalyst and the best "analisando" and it does not work.
We are not talking about something that is scientific.
It requires other skills, other approach... it has nothing to do with psychiatry.
Nothing.
Paul,
Why do you want to talk to someone who will never think that what you say is of any value?
I didn't read what you've wrote first but I can imagine the kind of questions you are being submitted because I have already been at your place.
You will be asked, and asked...
The sad is that it's not even the Aristotelian kind of question.
It's only to confuse you and impose you a truth that you are already aware if you have been treated by a psychiatrist.
I don't see any reason why... blah... blah... blah..
I would love to have a good psychiatrist at this blog.
But as I already said they don't have time because they have to take care of their patients.
My neighbor is an intern in the mental institution at my street.
You cannot imagine the absurds she tells me.
I pretend I don't understand anything and nod.
Psychiatry is like other fields: it requires time.
Unfortunately at the expenses of people's health and some even with time learn nothing.
Posted by Ana at May 27, 2009 01:36 PM
Now, I asked two questions earlier that I think should be answered in order to strengthen the position of those who believe in an immortal soul.
Please tell me (a) what a soul is and what it does that makes it so essential, and (b) how you know about the soul.
Thanks!
Posted by: dguller at May 27, 2009 05:17 AM
A soul is indefinable and subjective..
That's the whole point..
Don't you get anything?..
Can you think even slightly abstract for two seconds without retreating to the safety of your psychiatric dogma and ideology?..
I know what I know , and that's ok with me..
And I am also comfortable with not knowing everything and defining everything and labeling everything..
What is it with you psychiatrists and your labels?..
It would be safer for all of us if you stopped labeling people and maybe got a job in a supermarket labeling prices on tins of beans...
What makes you so uncomfortable with indeterminacy Guller..
Don't you realize that the entire experience of human existence is indeterminate? ..
Does that freak you out too much? Is that why you are obsessed with labeling the human condition? Do you feel the need to control ? ... and if you do... you should ask yourself... why?
Posted by truthman30 at May 27, 2009 03:35 PM
Paul:
Sorry, but I’m still confused.
The “lack of clinical utility of brain scans”? In your medical practice, do you not order CT and MRI scans of the brain for diagnostic purposes? I’m not too sure what area of medicine you practice as a physician, but you must have ordered such scans at some point, no?
And I’m not too sure what the problem is with the mathematics that processes the input data into a final image or representation. There is mathematical equations involved in pulse oximeters, as well, but that does not imply that the oxygen saturation values they present are thus fraudulent. And what is so suspicious about the computer programming that analyzes the VOLUME of activity in a particular brain region when following radioactive ligands attached to neurotransmitters? There is no deeper model of mental illness involved in such a test, at least as far as I can tell.
However, again, you are right that right now, the best that can be done is to compare the brain activity of subjects with a property of interest to those who lack that property (e.g. depressed versus not depressed), and to see if there is a difference. Perhaps this can lead to the biological correlates, and perhaps not, but it is certainly worthwhile to explore this area as far as possible.
But that does not mean that once the neurobiology of love, for example, is fully elucidated -- assuming it ever could -- would mean that that is all there is to love. Love has connotations and subjective components that require going beyond the brain, and it would be foolish to reject them and replace them with neurobiology.
Posted by dguller at May 27, 2009 04:20 PM
dguller wrote:
"...However, perhaps a common thread would be that all schools state that psychological distress is secondary to internal conflict or tension that is the result of an inadequate developmenent during the course of one's life...
...The focus is both upon the content of what is said, as well as the therapeutic relationship itself, which is looked upon as the primary vehicle of healing."
OK, well the various "camps" don't interest me - if any one of them had hit on "the Answer," then they'd all be doing the same thing, by now!
You'll have to forgive me translating your jargon into more familiar (to me), language... I take it, then, that the phenomenon known as "mental illness" is believed to be caused by a certain deficiency in our coping and other mechanisms, at some indeterminate point in our past, (but probably during our formative years?)? In the absence of "effective" mechanisms (ie, mechanisms that give rise to an appropriate outcome, as established against some kind of subjective benchmark, or objective), we then develop ad hoc responses, which may be inappropriate in later life. We may then enter a relationship, which exposes our deficiences, whatever they may be (or else the relationship is just so extreme that nobody could be expected to cope with it!), and we may start to experience this "double bind" thing, which we discussed, earlier, as we thrash around, not knowing what to do. Have I summed that up accurately?
A person may then become aware that they are not coping, although they may not understand why. They then present the issue, as they understand it, to you, and you seek to sift through what is said in order to get to the nub of the issue, and apply some kind of fix?
You'll perhaps forgive me for parroting your words back to you, but I rarely understand a single word that is said to me, to be honest, and I try not to take anything for granted, these days.
Incidentally, when you write "the focus is both on the content..." does that mean that merely having somebody to offload to/on is of therapeutic value?
Matt
Posted by Matthew Holford at May 27, 2009 04:21 PM
truthman30:
You wrote that the "soul is indefinable and subjective".
There are problems with that idea, as Ludwig Wittgenstein pointed out regarding the impossibility of a private language, a point earlier made by Plato in his Theaetetus, I believe. After all, if the word "soul" has no agreed-upon definition and can mean whatever anyone wants it to mean, then how can you tell when someone is using the word properly?
What if someone told you that their soul was sitting on their head and dancing a jig? Or that their soul was washing their car while they were watching television? Or that their soul was terrorizing their children by giving them nightmares? Or that their soul is an Irishman named Mike who sits in a bar, telling stories?
Would you agree with them, because that is their subjective experience, or would you think that they misunderstood what a soul is? How do you know that they have misunderstood? Couldn't they say, "Well, I think the soul is an invisible horse that washes cars"?
There must be SOME defining features of the soul, because otherwise, it becomes totally meaningless and incoherent. Even you prove that it can't be totally "indefinable", because you defined it as something that is subjective! That is a defining feature! Why not provide some others? I am not expecting that there will be a perfectly adequate definition of something like the soul, because some things are beyond language and human thought, but there must be some aspects of the soul that can be described by language and concepts. Otherwise, the word "soul" is equivalent to the word "groflit", i.e. a meaningless collection of letters.
And this has nothing to do with psychiatry or its dogmas and ideologies. It is just logic. If you have a problem with logic and reason, then you are free to reject them, if you wish. I'll stick with them, especially since without them, science and evidence become meaningless.
You once asked me whether I ever read philosophy. Well, I actually do read a lot, and one of my majors is in philosophy. And this is what philosophers DO. They ARGUE. They do not hurl insults and believe that they have won the day. Ultimately, the logic and evidence prevail, not one's capacity to hurt one's interlocutor.
Oh, and I do not believe that human experience can be fully captured by human language and concepts, just like many other things, but not because it is somehow mystical, but only because our language and conceptual categories are limited, because we are limited. However, there is a difference between saying that we cannot capture ALL of human experience in categories, and saying that we cannot capture ANY of human experience.
Finally, *sigh*, I am not freaked out, do not obsess about labelling the human condition, and have no need to control. For God's sake, we are both healthy, ordinary people having a discussion. There is no pathology or character defects in either of us. And even if there was, that is irrelevant to the LOGIC and EVIDENCE, which stand on their own. Otherwise, we will commit both the fallacy of ad hominem, and the genetic fallacy, both of which invalidate an argument.
Posted by dguller at May 27, 2009 04:38 PM
Ana wrote:
"Psychoanalysts who only follow the multiple bibles are not good...
...I assure you that there are good therapists who cares a lot about their "analisandos"...
LOL - I dread to think what the translation of "analisandos" might be (which presumably demonstrates a lack of maturity, on my part)! Anyway, judging by what both you and dguller have said, it seems that psychiatry is not a discrete discipline, in and of itself, but an accumlation of skills drawn from "traditional" areas of the arts, science, philosophy, sophistry/rhetoric, and so on.
I confess, given the way that dguller describes mental illness (ie, he seems pretty clear on the root cause of most of this stuff), I am confused as to why we (ie, mental healthcare, generally), have this fixation with the DSM and drugs. If one knows what the problem is, and where it stems from, then the solution ought to be self-evident. Oughtn't it?
The means of achieving the solution might be less clear, of course, but that's another matter. That is, one might have lost interest in the things that one used to enjoy, feel ignored and lonely and all that other stuff that's listed in the DSM, and thus be "depressed". The solution is to not feel ignored and lonely and to rediscover what one enjoyed about those old passtimes, which sounds like a statement of the blindingly bleeding obvious, and yet, sometimes the obvious needs to be stated!
Matt
Posted by Matthew Holford at May 27, 2009 04:45 PM
If you have ever actually listened to someone in the throes of grief , you will know the essence of a soul, if you ever had the unfortunate experience of suffering a deep and long lasting depression, you will see the depths of the soul and if you ever had the experience to witness someone rise again from an SSRI induced withdrawal nightmare , you will bear witness to the strength of the soul...
Stop labeling Guller..
And start humanizing..
Your life is indeterminate, human knowledge is indeterminate, the very act of existing is indeterminate..
Sweep away the mist of the psychiatric ideology that you hide in and begin to listen to the people who post regularly on this site and then you might then begin to come back down to where us humans dwell ...
Psychiatry has brainwashed you ..
You've been duped..
Posted by truthman30 at May 27, 2009 06:33 PM
Matt,
I don't know the English translation.
I'm sorry. I didn't make myself clear because the conclusions you arrived have nothing to due with what I understand of psychoanalysis.
"as Ludwig Wittgenstein pointed out regarding the impossibility of a private language, a point earlier made by Plato in his Theaetetus, I believe."
Wow! Nobody knows that and dguller study so hard Wittgenstein and Plato that he just found it out.
By the way, people who discuss philosophy hardly use the first name of the author.
I find it amazing people appealing to authority of theoreticians that they know a few lines and are... blah blha blajhl
I will not participate in this kind of threats any longer.
Too much words and plenty misunderstandings
Posted by Ana at May 27, 2009 06:48 PM
Matt:
Matt:
I was only stated the psychoanalytic theory of mental illness, and was not necessarily endorsing it. I think that psychoanalysis utilizes a variety of very useful techniques in order to engage patients in an empathic manner and to bring their maladaptive patterns to their conscious awareness through transference reactions to better work on them, as well as to assist them in both letting go of harmful narratives and replace them with healthier ones. However, I think that their theory of mental illness has been generally debunked, except for a few core ideas -- e.g. unconscious processes, the influence of early childhood upon internalizing different cognitive-emotional-behavioural schemas, defense mechanisms and coping styles, and so on -- that have been usurped by other theories that have more empirical evidence.
Posted by dguller at May 27, 2009 07:01 PM
Guller,
I think scans are used to lend scientific credibility and justification for psychotropic drug treatment. They are used to convince people they have a lifelong incurable disease that will require a lifetime of drug treatment. A picture is worth a thousand words. That's the only clinical utility I see.
Otherwise, CTs and MRIs are useful for diagnosing and assisting in the treatment of many physical ailments. However, I'm not going to order an MRI or CT or any other radiological scan to determine if a person is depressed or not. I might order such to look for pituitary or hypothalmic issues, for other lesions, or for a brain injury - all physical problems. I'd never order one to ascertain if a person is bipolar, depressed, or any other psychiatric label - they are useless for these sorts of determinations. Why is this so unclear to you? Why do I even need to spell it out?
Pulse oximeters do not use complex statistical methods to translate an signal to an A/D converter to an oxygen% - they aren't really any different than a pH meter or measuring respiration rates. I used to build instruments (yes, both the hardware and software) in a professional capacity so I'm not a bit unfamiliar with how such things work.
Imaging is more akin to global warming modelling (if you are wise you won't get me started on this either...) in terms of complexity and input parameter assumption dependence. The lack of what clearly delineates "normal" from "disease" cannot be minimized, understated, or swept under the rug. The fact that normal labs also suffer this problem to varying degrees does not umbrella brain scanning as sufficiently robust for clinical use. Nice strawman attempt or in the nouveau parlance: Epic Fail.
How the data is rendered is also not an unimportant aspect. You have to realise what you are seeing is NOT real in any sense. It is simply an interpreted model of the data, formatted for a particular sort of display which may actually occlude it's true meaning.
Ana,
You're right. It's futile.
Posted by Paul at May 27, 2009 07:38 PM
Ana:
Actually, I took a full course on Wittgenstein in university, and so did a little more than learn a few lines. I didn't just google him to appear smart.
And just so you know, people who study and write philosophy use the first names of other philosophers ALL THE TIME. And no, it does not mean that they are unfamiliar with their work. I have no idea where you got this idea from.
Oh, and when I wrote "I believe", I was referring to my uncertainty about whether Plato's proto-private language argument was in his Theaetetus or his Phaedrus, not about Wittgenstein's argument itself.
Posted by dguller at May 27, 2009 08:26 PM
truthman30:
If you ever peer into the river, you will see the "goldrit". If you ever gaze into the eyes of a child, you will see the "goldrit". If you ever feel the rhythm of music, you will know the "goldrit".
Stop being brainwashed and open yourself to the "goldrit". You are too narrow-minded and arrogant to actually understand the "goldrit". Try being a human being, and then you see see the "goldrit".
How does that make any more sense than what you wrote about the soul?
I mean, come on. If you see a soul whenever someone is in distress and manages to overcome it, then do you see a soul in a dog who is injured, but still manages to save its owner? Do animals have souls? If yes, then what is so special about the human soul? If not, then how do you know this?
And it doesn't help your position to declare that I am ignorant and brainwashed, because I can easily say the same thing about you and the "goldrit".
If you cannot defend the soul, then be quiet, and let someone else argue for its existence.
Jeez, I didn't even bring up the soul on this thread! :S
Posted by dguller at May 27, 2009 08:42 PM
truthman30:
Oh, and one more thing.
You wrote: "Your life is indeterminate, human knowledge is indeterminate, the very act of existing is indeterminate".
My life is indeterminate? Yes, in the sense that my future is open, but my past is closed and fixed. So, my past is certainly determinate, whether anyone is able to know all the details or not.
Human knowledge is indeterminate? Yes, in the sense that we are constantly learning new information and revising our previous knowledge base. But, does that mean that all our beliefs are equally up for grabs? Aren't some beliefs so foundational to our conceptual framework that relinquishing them would unravel the whole thing? Isn't it determinate, for example, that "1 + 1 = 2"? What would it even mean to say that "1 + 1 = 2" is indeterminate?
I like Wittgenstein's analogy in his On Certainty where he describes our beliefs and practices as similar to a river flowing over a riverbed. There is change (indeterminate), but there is also stability (determinate). Fortunately, we have both in our existence.
The very act of existing is indeterminate? Yes, in the sense that by existing, one is part of the flux of the natural world, and thus is constantly changing. But, the fact that I do currently exist is determinate. There is no vagueness or lack of fixed precision in the statement that I do exist at this time and in this space. Also, the fact that my existence operates according to determinate laws of nature is another strike against the essential indeterminate nature of existence.
I think it would be more accurate to say that our lives, our knowledge, and our existence manifest both determinate and indeterminate aspects.
What do you think?
Posted by dguller at May 27, 2009 08:59 PM
Paul:
Sorry! I thought that when you were criticizing the diagnostic utility of functional imaging, you were referring to ALL uses in clinical diagnosis and only using them as research tools. I thought that your rationale was that since the resulting image is the product of complex mathematical equations that it is somehow invalid and not useful, which would have made CT and MRI scans also invalid. Thanks for clarifying that your objection was solely in terms of using functional imaging to diagnose mental illness, which as far as I know, no-one is advocating.
Now, help me understand how labelling serotonin, for example, with a radioactive ligand, and monitoring whether there are differences in serotonin levels between a large enough group of depressed individuals compared with appropriately matched non-depressed individuals, would not be useful. If serotonin levels made no difference whatsoever, then that would be detected in such an experiment, wouldn’t it? I mean, doesn’t functional imaging detect the amount or volume of radioactive tracers in a given area of the brain, and couldn’t it detect differences in amount of neurotransmitters in different parts of the brain? The serotonin is going SOMEWHERE and can be detected. That’s not manufactured by mathematics, is it?
Is there something in the theory of this notion that is unsound? Is the objection that the experiments have already been performed and the results been inconclusive? Is the problem with both theory and results?
Your knowledge in this area is definitely far greater than mine, and I’d like to know why this approach would not be useful, for my own education.
And what would you recommend to be a scientifically valid method of studying the brain’s relationship to the mind? Is there one?
Thanks.
Posted by dguller at May 27, 2009 09:57 PM
Congratulations dguller!
You are a very intelligent person the personification of wisdom in all fields.
I believe you should write a book, start a blog, I don't know, so something to spread your knowledge.
You speak to few people here. I also took a course on Charles Sander Pierce in university and still remember the basic to pretend I know it all. Strangely enough I got "A" as a grade.
I'm also very good in talking about cooking because once I attended a one week workshop. I can talk about cooking as if I were a chief but can't cook rice.
I've got "the idea" by the time I was married to a French philosopher and got in touch with many people like Gandillac and... never mind. It most be a difference of cultures: in Brazil and France people say Nietzsche but in US Friedrich Nietzsche, Soren Aabye Kierkegaard, Sigmund Freud, Karl Marx, Ludwig von Beethoven, Francis Bacon, Karl Popper, Alfred Nobel, Alfred Hitchcock, Alexandre Gustave Eiffel...
I have already heard:
"I love the Alexandre Gustave Eiffel Tower! I believe that Alexandre Gustave Eiffel should receive a Joseph Pulitzer prize. Oops, his already dead."
Paul,
Yep, futile.
But you have some explanations to answer. :)
There are plenty good topics to comment.
Posted by Ana at May 28, 2009 02:24 AM
Ana wrote:
"...I will not participate in this kind of threats any longer.
Too much words and plenty misunderstandings."
Well, dguller's only correspondence on this thread has been to defend himself from attack, from what I've seen (it's worth remembering that he's not responsible for all the ills of psychiatry (unless he's Blendleblurb, writing under a nom de plume, that is!)). He's comfortably outnumbered, and it's difficult to function properly, under those circumstances.
Matt
Posted by Matthew Holford at May 28, 2009 02:44 AM
dguller wrote:
"I was only stated the psychoanalytic theory of mental illness, and was not necessarily endorsing it...
...that have been usurped by other theories that have more empirical evidence."
OK. Erm, a question: who decides what a "maladaptive pattern," and a "harmful/healthy" narrative is, given that these things can never (and shouldn't), be objectified, I should have thought?
Anyway, the reason I asked what the objective of psychiatry is/was is this: I've noticed that when people have no objective, they are relatively easily led off at a tangent. The Worshipful Company of Apothecaries (my nickname for Big Pharma), has a very clear objective, which has little, if anything, to do with patient wellbeing, as far as I can ascertain. Psychiatry has got into bed with The Worshipful Company, and appears to be pursuing The Company's aims. Did psychiatry ever have an objective of its own?
The thing is, it doesn't necessarily matter what one's objective is, provided one is satisfied that it is beneficial. If one is a psychiatrist, I should imagine that the only "good" objective is one that benefits the patient, and has the patient very firmly in mind.
As a matter of interest, do you ever explain to your clients the process that you are going to follow (ie, "we're going to look at your maladaptive patterns, and see if we can maybe modify them, so that they work better.")? Or do you keep that a secret (either deliberately, or inadvertently)? People tend to work better, when they think they're part of a team, looking to achieve the same objectives, previously agreed, rather than somehow being controlled for some purpose that is never going to be disclosed, until it's too late. For some people, being kept in the dark is a trigger, in and of itself, even if they've lived in the dark all their lives, and can navigate it reasonably efficiently.
Matt
Posted by Matthew Holford at May 28, 2009 02:58 AM
What do I think? ..
I think that you are a man who is deeply entrenched in an illusion built on an outdated paradigm of psychiatric opinions...
I think that you are conceited , not unlike the Euthyphro in Plato's dialogue , you claim a conceit of knowledge , and considering your position , that conceit has the potential to cause great harm to mental health patients ...
I think you are posting on this site purely to aggregate discontent...
I think you have zero respect for those suffering from mental "illness" ...
I think you should be ashamed of your part in the promotion of the ideology of psychiatry , an ideology with a gruesome past history and presently with a corruption so great it defies all moral and ethical constructs (as illustrated in numerous articles on this very site alone)
I think you are so blinded by your own ego that you have lost the ability to see the reality of what your profession really does ..
But you don't really care what I think do you?...
Posted by truthman30 at May 28, 2009 03:28 AM
Ana:
I'm nowhere near the "personification of wisdom in all fields", and have never claimed to be. Actually, as Paul has demonstrated, I actually know virtually nothing about functional imaging! But hopefully he'll be able to teach me a thing or two. ;)
I know some things pretty well, and many, many others that I know nothing about. Wittgenstein just happens to be one topic that I am somewhat familiar with, but I am nowhere near an expert on his thought. :)
Charles Peirce, eh? That's interesting. I don't know much about him. What attracted you enough to take a course on him? All I know about him is that he is one of the American pragmatists. I've read a few things about William James and John Dewey, but not much about Peirce. Any of his works that you would recommend as worth reading?
Posted by dguller at May 28, 2009 04:21 AM
Ah, yes. The conundrums of experimental design.
If I had a hypothesis that elevated serotonin was caused by feeling or behaving in a certain way, and only that way, I might think I could design an experiment to measure serotonin (by signaling or otherwise) and confirm or falsify my hypothesis. Or, I might have a hypothesis that elevated serotonin caused particular feelings or behaviours. I'd want to be sure I could separate which group I was measuring. How would I be sure each group was comparable. I'd use cloned mice to eliminate any structural, environmental, or social co-factors. Great now I have a comparable substrate. Oh, I also wouldn't have subjected my clones to any brain disabling treatment prior to one I'll perform. Oh, I'll have to make sure when I inject these guys and gals with my radio-labelled serotonin that it behaves the same same in the body and does not cause any uncontrolled for effect itself. No matter. Oooo, look at the data. I can't interpret it this way. I need some one to make me a picture so I can understand what I'm seeing. Ah, that's better. Oh wait, no it's not. How come I don't have distinct groups? No matter these guys have more serotonin than those guys. See how much I've learned! Now, let's do it in people and make me some money!
Futile.
Posted by Paul at May 28, 2009 06:35 AM
Paul:
Thanks for describing the ideal experiment using radiotracers to identify neurotransmitter levels in different brain regions in order to correlate them to mental states.
You make a fair point about the inability to identify the direction of causation between serotonin levels and mental states using such a method. Perhaps the best that we can hope for is to find a robust correlation, and then afterwards attempt to figure out what direction is of the causation (or whether there is a third factor causing both).
You are also right that the ideal comparator group would be identical genetic clones with identical life histories and environments. But is that absolutely necessary in order to find genuine differences between two groups? If that were true, then wouldn’t research that didn’t include cloned animal models ground to a halt? And even research that did include them could be critiqued that there is no way to completely control their environments, and there would inevitably be differences between them.
I suppose that you could state that for physical illnesses there are biological correlates in the form of pathological studies, for example. But if you are going to be totally rigorous, then couldn’t I reply that the incision or injection that removed the tissue possibly altered it, thus confounding the result? We would need a way to extract tissue without disturbing it at all, which appears impossible. This would appear to fall prey to a bastardized version of Heisenberg’s uncertainty principle, no?
We can never hope to have identical groups to compare, but only to control as best as we can for confounding factors, and try to find a robust signal in the data to indicate the presence of a true phenomenon. Now, where the signal is weak, there are legitimate arguments regarding the influence of confounders and the inconclusive nature of the evidence, but if the signal is strong, then doesn’t that indicate something potentially real (assuming it is replicated by independent researchers)?
You make a good point about the need to ensure that the radiotracers did not interact with bodily mechanisms to cause a subsequent change in the brain that is being detected by the functional imaging. That would be an example of the third factor accounting for the correlation that would have to be uncovered by other experiments and then factored into the equation, if possible.
Finally, I think that the likely absence of two distinct groups in the final analysis is not necessarily a criticism of this approach. I mean, we are talking about continuous data, not unlike blood pressure, heart rate, laboratory values and so on. There is almost always going to be a grey area of overlap due to the variation involved in the groups being studied. The question is whether there are differences between the two groups that are statistically significant and meaningful. In other words, can the overlap be accounted for as purely the result of chance?
Now, if the data itself is generated using suspicious mathematical models that are based on invalid assumptions, then that is definitely a cause of concern, which you raised with regards to functional imaging. I don’t know enough about this topic to make comments on it, but I would hope that the underlying assumptions are not invalid. You’d have to take up that matter with the experts. :)
Paul, I think that if your level of precision and rigor could be performed in clinical research, then it definitely should, because it would make the results much more firm, but the reality of the situation is that perfection is impossible, and we have to make due with the methods that we have, while being aware of their limitations (which you mercilessly pointed out). Fortunately, research is not traded on certainty, but probability. P does not have to be zero, but less than one in twenty. That may be wrong, but that is the current standard.
Now, other than the process that you outlined in your post, are there any rigorous methods available that you approve of to shed light upon the relationship between neurobiology and mental processes?
Is there any hope, from your perspective? Or is the brain fundamentally a black box?
And thanks again for providing invaluable criticism of my views.
Posted by dguller at May 28, 2009 10:34 AM
Matt:
You are right that maladaptive pattern is a fuzzy concept, like most concepts in psychiatry and psychology. I understand it to be a recurrent pattern -- often performed outside of their awareness -- that is interfering with a person’s ability to satisfy their needs and embody their personal values.
I never tell them up front that I think their pattern is maladaptive, but ask them whether thinking and behaving the way that they do is helping or hurting their goals in life. If they say it is helping, then we examine the evidence to see if that makes sense. If they still say it is helping, then we move on to something else that they think is problematic. If they accept that their pattern is hurting them, then I ask whether a change would be beneficial.
And I always tell them what I think about what is going on and include them in the therapeutic process. It has to be brought to their conscious awareness so that they can begin to exercise some control over it, and then it is a matter of helping them understand it better, including its origins and sustaining factors, and to offer them alternatives that are more likely to help them be who they want to be.
My approach is to use components of schema therapy, EFT, CBT and ACT, as well as some smattering of psychoanalytic techniques. And always to engage in a collaborative relationship with them, because they have a stake in their recovery and must take ownership of rising above their difficulties and choosing in a way more consistent with their values and needs.
Posted by dguller at May 28, 2009 10:44 AM
truthman30:
Of course, I care what you think. I wouldn't ask you questions or respond to you if I didn't. I would IGNORE you in that case.
I just wish that you would engage the content of my posts instead of insulting my character. I think that would lead to a fruitful discussion in which both of us might learn some important things.
I know that I have a lot to learn, and certainly don't have a monopoly on the truth, but I do not accept positions lightly, being skeptical by nature.
Posted by dguller at May 28, 2009 10:49 AM
Matt,
Here I am.
You haven't seen the way Stephany and other people were treated during the two months you only saw a single name in "Recent Comments". You were not coming to FS by that time or didn't notice.
He has silenced all commenters. Truthman30, Sally and Bob sometimes and I don't remember who else were the only who tried a dialog but were silenced.
dguller,
Charles Sanders Pierce interested me because I have a M.D. in Literature.
Read "Collected Papers". I'm sure you'll like it.
Truthman30,
I totally agree with you!
"What do I think? ..
I think that you are a man who is deeply entrenched in an illusion built on an outdated paradigm of psychiatric opinions...
I think that you are conceited , not unlike the Euthyphro in Plato's dialogue , you claim a conceit of knowledge , and considering your position , that conceit has the potential to cause great harm to mental health patients ...
I think you are posting on this site purely to aggregate discontent...
I think you have zero respect for those suffering from mental "illness" ...
I think you should be ashamed of your part in the promotion of the ideology of psychiatry , an ideology with a gruesome past history and presently with a corruption so great it defies all moral and ethical constructs (as illustrated in numerous articles on this very site alone)
I think you are so blinded by your own ego that you have lost the ability to see the reality of what your profession really does ..
But you don't really care what I think do you?... "
Yes, that is exactly what I think and I have said the same as you.
Not only by the "ego" but by just having a license to "treat" others unfortunately following the "bible", Mein Kampf included.
I don't know anybody who likes to have a young doctor. You know that theory in practice changes.
But my GP is not that old but dear Lord! The man raises many hypothesis and has fixed some ailments. I really like him and i love when he says "I hate some of my colleagues." LOL
I have already said some months ago that dguller should stop because he is not doing a good work defending psychiatry this way.
If I was a psychiatrist I would tell him to stop his show at a blog.
A blog that is a source of knowledge for good psychiatrist.
I'm sure that many psychiatrists use FS as a source of data.
They remain silence in respect for the patients who are here and because they really don't have time.
Paul,
As I said before there are numerous neurotransmitters that are not even known.
The chemical imbalance that the whole brain and body suffers due to the use of SSRI, SSNI and others psych-drugs will be recognized in the future as one of the dark ages in psychiatry history.
Unfortunately I believe I will not be alive.
Serotonine is responsible for many other things known and unknown.
Here I am junked to Effexor for life after 22 months of the hell of withdrawal.
I can tell you that what I felt in my body, mind and soul entitles me to say plenty of things about these drugs.
As an example: serotonine has a role in temperature of the body: I felt "cold and hot at the same time". Yep, you've read well. One of many strange feelings I experience in 22 months.
It's amazing that all I and others have to say is not taken seriously. I don't believe we are telling any news for researchers. blah blah
Just like a Brazilian psychiatrist I know who has tried Wellbutrim.
He is the only one who has listened to me with real interest.
And what about psychosis in DSM-V?
Isn't it amazing?
We will have Bipolarity 1, 2 and psychosis maniac-depressive.
What a great collection!
Why are we stuck here at this post?
It looks like that Buñuel movie that people cannot leave the party.
I'm sure I'll have to come back later.
I'm tired of typing.
I have Skype now.
If you want we can have a chat. LOL
As Roland Barthes used to say:
"Language is fascist."
"The fascism is not shutting up. It's force speaking."
NO PHILIP! You are NOT invited. I respect your low profile and even admire it.
See you later!
Posted by Ana at May 28, 2009 11:57 AM
dguller, your comment: "I never tell them up front that I think their pattern is maladaptive, but ask them whether thinking and behaving the way that they do is helping or hurting their goals in life. If they say it is helping, then we examine the evidence to see if that makes sense. If they still say it is helping, then we move on to something else that they think is problematic. If they accept that their pattern is hurting them, then I ask whether a change would be beneficial"
is more than a little disturbing because you are assuming that only YOU are qualified to make these assesments (which of the patient's behaviours are helping or hurting) and it's up to THEM to "accept" your point of view. Yuck. This reminds me a lot of what passes for "insight" in a patient (basically, agreeing with everything the psychiatrist says). There's potential for abuse in psychology, too. I think far too many psychologists need to impose their point of view.
Posted by Francesca Allan at May 28, 2009 12:46 PM
dguller wrote:
"...My approach is to use components of schema therapy, EFT, CBT and ACT, as well as some smattering of psychoanalytic techniques. And always to engage in a collaborative relationship with them, because they have a stake in their recovery and must take ownership of rising above their difficulties and choosing in a way more consistent with their values and needs."
OK... I'm not familiar with the peculiarities of the methodologies you mention, obviously, although my experience tells me that a counsellor might be qualified in all these things, and develop their own style, therefrom.
What you've written looks perfectly plausible, not to say logical. What, then, I ask myself, is the criticism of psychiatry, aside from its (relatively), recent high-profile conflict of interest/corruption allegations? Put another way, why do people believe it is actually detrimental?
OK, let's say that you've realized that there is a trend in your relationships that worries you. Let's say that you perceive that your attempts at communicating with people (particularly new acquaintances where there is no formalized structure), tend to end in acrimony, and this concerns you (I'm globalizing the exchanges you've had with a couple of people on this board, for the avoidance of any and all possible doubt).
You convey your experience to me, because you're concerned that it's somehow your fault, but you're not clear as to how you might conduct yourself differently, in order to get a better result. I then deconstruct the thing, as represented, by you, to the best of my abilities and attempt to suggest alternative approaches that may achieve better results, in the sense that you put your message across without people feeling belittled, or whatever.
Is that more or less how it works?
Again, even interpreted through my own prism, I find myself seeing this as acceptable. At what point, then, does the system turn into the Spawn of Satan, for some people?
Matt
Posted by Matthew Holford at May 28, 2009 01:42 PM
Ana:
Thanks for the recommendation. I'll definitely look into it.
Take care.
Posted by dguller at May 28, 2009 01:58 PM
Francesca:
I think you misunderstood.
Given the history that I have taken, I have hypotheses about what life patterns may be maladaptive and contributing to their struggles. I do not claim to know with certainty, but only suspect and wonder. I then tell them what I think is going on and then ASK them if it fits their experience. If they disagree with my understanding, then that is fine. I do not chalk that down to denial or resistance, because I could be wrong.
Ultimately, I try to help them develop a narrative that they can emotionally and intellectually connect to, and that empowers them to move forward and build a life in accordance with their needs and values. More importantly, it is a narrative that we have co-created together through exploring their inner world. Through working together, they learn to have a new relationship with their thoughts and feelings, as modelled in our interaction.
You see, it is all about them, not about me.
Posted by dguller at May 28, 2009 03:00 PM
EFT?
http://www.emofree.com/newcomer.htm
This one here using acupuncture?
It must be very interesting. The only thing that scares me is that if acupuncture is not done correctly it can harm you. Yep. I have been treated by a great one. Fine. A decade after I had problems with another pro. Be careful!
There is a try it yourself manual saying that no previous training is required.
It's scary!
ACT I didn't find any link at Google to therapy.
There is American Conservatory Theater.
It might help. Remember that techniques of dramatization from the seventies?
Posted by Ana at May 28, 2009 03:14 PM
dguller,
Not at all! It's a good book.
Matt,
Yep,
It makes sense. Guilty, guilty...
It's so complicated because sometimes we blame the other.
I'm confused now.
Posted by Ana at May 28, 2009 03:20 PM
Matt:
Anyone who has had their personal integrity and dignity violated through being deceived and coerced into receiving treatment that ultimately ended up harming them would feel the disgust and revulsion that people here feel towards psychiatry. Of course, those negative feelings would be multiplied exponentially if important aspects of the rationale behind the treatments was discovered to be corrupt and fraudulent from the onset.
I appreciate your efforts to meet me halfway and to have a respectful dialogue with me. That is the consequence of seeing each other as unique individuals who can disagree without implying that the other person is somehow blinded by propaganda, enshrouded in illusion, and disconnected from human sentiment due to their vile and monstrous character.
Unfortunately, since I do not prostrate myself and declare that my profession is the embodiment of evil and fraud on earth, I will ever be perceived as a monster and beyond the pale by many visitors to this website. And given their experiences, that reaction is not entirely unexpected or unreasonable, but it is a shame nonetheless.
Posted by dguller at May 28, 2009 04:22 PM
Ana wrote:
"Matt,
Yep,
It makes sense. Guilty, guilty...
It's so complicated because sometimes we blame the other.
I'm confused now."
LOL... I've spent my whole life in a state of confusion! Like I wrote: if it's what you're familiar with, navigating in the dark is something one becomes proficient in!
Matt
Posted by Matthew Holford at May 28, 2009 04:23 PM
Ana:
No, no. :)
EFT is Emotion Focused Therapy, pioneered by Leslie Greenberg.
ACT is Acceptance and Commitment Therapy, pioneered by Stephen Hayes.
Posted by dguller at May 28, 2009 04:29 PM
Matt:
One more thing.
Your description above is, generally, how it works. Well put. :)
Posted by dguller at May 28, 2009 04:32 PM
dguller wrote:
"...One more thing.
Your description above is, generally, how it works. Well put. :)"
Thank you. Really. Viz your previous comment, to me: as I wrote, before, experience is a terrible thing, sometimes, and like Pavlov's dogs, we may find it hard to see the world in a different way, once we've had a bad (or, indeed, good), experience with a given thing/situation.
The funny thing is, there are people in this world who apparently deliberately (and I don't mean "consciously"), go looking for people's negative triggers, and every time they oblige a person to visit that initial, negative state, the experience becomes more intense. The people who do this appear to do it for their own gratification, or release.
My own belief is that, in one sense, they're explaining how they have been treated, because any attempt to complain has been invalidated. Whatever the reason, such people are to be found in all walks of life. All they ever really want is somebody to listen to their story, and the saddest thing is, when one lends an ear, they often can't articulate what they've experienced.
Matt
Posted by Matthew Holford at May 28, 2009 05:40 PM
Matt:
Well, I think that in some cases, re-exploring dysphoric feelings secondary to a traumatic experience is a necessary part of the healing process. As Leslie Greenberg says, you cannot leave an emotion until you have arrived in it fully first, because it will leave residual traces that are unaccounted for. However, that re-experiencing is done after a strong therapeutic bond has been formed between the clinician and the patient. Going too fast, too soon, can just re-traumatize someone for sure.
And you are right that all most of us want is to feel like we matter to others, to feel understood by another without judgment, especially when this has never happened before to a significant degree. The pain of rejection and abandonment is some of the worst pain there is, and it can initiate a process that just leads to more rejection and abandonment by pushing people away in the very process of desperately trying to pull them close.
Posted by dguller at May 29, 2009 06:56 AM
Matt,
You write:
"The funny thing is, there are people in this world who apparently deliberately (and I don't mean "consciously"), go looking for people's negative triggers, and every time they oblige a person to visit that initial, negative state, the experience becomes more intense. The people who do this appear to do it for their own gratification, or release."
Maybe a real world example would help.
Uh, are you saying you think there are people in the world who don't do this? People who alawys do this? Part of being human it seems is at times being selfish unknowingly. The idea that some people are never selfish is a mistaken one as is the idea that what you've described is an illness. We all need positive interactions with others but this doesn't mean we're all always going to behave perfectly or that we should think others who don't behave perfectly are sick.
Posted by Sally at May 29, 2009 10:53 AM
Sally wrote:
"...We all need positive interactions with others but this doesn't mean we're all always going to behave perfectly or that we should think others who don't behave perfectly are sick."
Hmmm. I think that there are, in essence, two systems at play in the world, and they conflict with terrible consequences. The first is the one espoused by everybody, and which everybody claims to subscribe to: equality. The second is the Law of the Jungle, aka survival of the fittest. This second system is interpreted in any way that people who susbscribe to it choose to interpret it. And it allows absolutely anything, taken to its logical extreme.
People who (secretly, or otherwise), subscribe to the second system see themselves as either winners, or losers. "Loser" has an extreme negative connotation, which they try to avoid at all costs. Winning is everything, and takes many forms, but requires that losers have to be manufactured. But, let me ask this: how does one "win" in a relationship, any relationship, with another human being, particularly using the second system?
For the avoidance of any and all possible doubt, I subscribe to the view that everybody possesses the same intellectual capacity as I, because I would go mad, if I thought differently, and God alone knows what kind of stuff I'd get up to, if I sought to win.
Matt
Posted by Matthew Holford at May 29, 2009 12:45 PM
dguller wrote:
"...The pain of rejection and abandonment is some of the worst pain there is, and it can initiate a process that just leads to more rejection and abandonment by pushing people away in the very process of desperately trying to pull them close."
You are right, of course, and this is widely known, too, which is why the threat of rejection and abandonment is a powerful tool of control, which is used quite indiscriminately, as far as I can assess. My family loves it: its the thing that it made first recourse to.
Matt
Posted by Matthew Holford at May 29, 2009 12:49 PM